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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Exp 50 years

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What do these ultrasound and biopsy reports indicate?

Answered by
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Dr. Jacqueline Brown

OBGYN

Practicing since :1996

Answered : 1425 Questions

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Posted on Sat, 10 Sep 2016 in Women's Health
Question: Hi doctor,
I am a practicing general physician.
My mother aged 56 years otherwise healthy complains of postmenopausal bleeding. When asked she says its been since 3 years but irregular. Also, had intermittent pain in the lower abdomen since the same duration. Bleeding and pain was intensified in recent days, which is the reason why she brought the matter out. I have got the USG and biopsy test done. Have an appointment for PET scan.
Please go through the attached reports and opine on what stage of the cancer she might be in. Also, please comment on the treatment modalities suitable for the stage you suspect.
I shall soon attach the PET scan report once I get. I need your opinion to formulate on what can be expected in the PET scan.
Waiting and expecting a quick reply.
Regards,
doctor
Answered by Dr. Jacqueline Brown 2 hours later
Brief Answer:
Your mother will need surgery and possible radiation

Detailed Answer:
Hello doctor. I hope I can help you today. I am a university-affiliated general gynecologist in the US. I reviewed the reports from you mother's ultrasound and endometrial biopsy and will attempt to clarify the situation for you.

Endometrial cancer can have multiple grades, but staging is accomplished surgically. She will at minimum need a hysterectomy, bilateral salpingoophorectomy, and pelvic lymph node dissection, ideally performed by a GYN oncologist. The fact that your mother's cancer is well-differentiated is a good factor towards her prognosis.

According to the ultrasound, she has a central endometrial mass. If the cancer is confined to the endometrium and does not invade greater than 50 percent of the uterine wall, hysterectomy can be curative and she may not need any further treatment. Radiation is indicated for disease spread deeper in the uterus of if her lymph nodes are positive.

The PET scan can give an idea whether or not she has disease outside the uterus, but the initial treatment will still be surgical. With the findings on your mother's ultrasound, it would be unusual to have disease spread outside the uterus. No one can predict what stage her cancer may be, but at this point there is no indication that she is beyond stage 1, which has an extremely good prognosis.

So I would recommend finding a GYN oncologist for your mother to consult with to arrange her surgery. Generally, a pelvic CT scan or MRI is done before sugery to image the pelvic lymph nodes.

I hope the information I provided you was helpful and that your mother is able to get treatment promptly. If I can be of any further assistance, please let me know.

I wish you and your mother the best during this difficult time.

Sincerely,

Jacqueline Brown, MD
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Jacqueline Brown 42 minutes later
Hi doctor,

Thanks for your valuable opinion.

Since my mother had post menopausal bleeding since 3 years, do you think the cancer has evolved over the entire duration ?

Could the metaplasia have occurred in recent days or months ?

Also, please enlighten me on what other subclinical illness can be expected or screened for in my mother at this stage.

Thanks again,
doctor
Answered by Dr. Jacqueline Brown 15 minutes later
Brief Answer:
It is not possible to know the duration that your mother has had cancer

Detailed Answer:
Hello again doctor,

There is no way to know how long your mother's endometrial mass has been there, however invasive uterine cancer is usually proceeded by hyperplasia, which can also cause postmenopausal bleeding. So she may have had preinvasive disease before the cells became cancerous, but there is no way to reliably know how long that process took.

Regarding other subclinical illnesses, I am not sure what screening you are referring to- but she should undergo mammography and colonoscopy as part of her routine health maintenance, and because there is an increased risk of both of these cancers in some women with endometrial cancer. These other screening tests should not delay her surgery though, as that is the essential first step in staging and hopefully, treating her. The only other test she may need, as I mentioned before, is a pelvic CT or MRI to image her pelvic lymph nodes.

Please do not hesitate to contact me if you have any other issues.

Best wishes again,

Dr. Brown
Above answer was peer-reviewed by : Dr. Raju A.T
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